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Preparing Hospitals, Doctors, and Nurses for a Terrorist Attack

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Publication Date: October 2002

Publisher(s): Hudson Institute

Author(s): Ronald W. Dworkin

Funder(s): Hudson Institute

Funder(s): Hudson Institute

Topic: Health (Health care planning)
Social conditions (Safety and security)

Type: Report


During the Cold War, a nuclear attack was the primary threat to American citizens. Hospital administrators and doctors were told to prepare for an enormous number of casualties, even though high-ranking officials whispered in private that there was really very little that the U.S. health care system could do. No amount of planning, they argued, could prepare the health care system for the mass casualties and chaos stemming from a nuclear exchange. With the end of the Cold War, and beginning with the terrorist attacks on September 11, 2001, the threat to American civilians has changed. Biological, chemical, and nuclear (“dirty bomb”) terrorism now constitute the relevant threats. Although this form of warfare can produce large numbers of casualties, the U.S. health care system can conceivably cope with these casualties, and save lives, if it is prepared.

Planning is vital in the new era because, unlike during the Cold War, the health care system can make a difference. Several key state and federal agencies are now actively coordinating our response to a potential terrorist attack, including, for example, the Federal Emergency Management Association (FEMA), the Centers for Disease Control (CDC), state public health departments, and local law enforcement. Their activities are important. But in the event of a terrorist attack with a weapon of mass destruction, the first people to deal with the situation will be the doctors and nurses at local hospitals. These people must be prepared in a way that agencies are not. Their quick and organized response is vital, for in many cases of biological, chemical, and nuclear terrorist attack, treatment must be received within hours if it is to be effective. Before looking at how hospitals, doctors, and nurses might prepare for an attack, several trends in U.S. health care need to be discussed, for they influence the planning process.